By the end of the 19th century, the Native population of southwestern Alaska had already been reduced by at least one-quarter because of epidemics of smallpox, influenza, measles, and other diseases introduced by non-Natives.

The first person to offer modern medical care to the Bristol Bay area Natives was a missionary named Dr. J. H. Romig, who ran a small hospital near the mouth of the Nushagak River between 1904 and 1906.In 1908, Dr. Linus Hiram French arrived to work as a cannery doctor for the Alaska Packers Association. In the winter of 1910, he served the people around Carmel, where a Moravian mission was active, and a year later he was charged to oversee the U.S. Government Hospital. The cramped facility was among the federal government's earliest attempts to provide formal health care to Alaska Natives. In 1913, French moved the hospital into one of two school buildings at Kanakanak on the Nushagak River, six miles downriver from Dillingham. Between 1915 and 1930, the Bureau of Education would open hospitals at Juneau, Akiak, Noorvik, Unalaska, and Tanana.

Dr. French was in charge of the Kanakanak Hospital in 1918-1919, when the Spanish influenza was spreading around the world, killing tens of millions -- more than one-half million people in the United States alone. The pandemic reached southwestern Alaska by spring 1919, taking the lives of hundreds, and leaving scores of children orphaned. Having heard of the flu's sweep across Alaska, that winter French tried to protect the people of the Dillingham area by urging them to limit travel and interaction with outsiders. However, when a Russian Orthodox priest arrived for an Easter service, he brought the disease with him. Within days, hundreds were dying and mass graves were hurriedly dug to bury the bodies. Some villages were abandoned, the living too sick or frightened to handle the dead. Elders today still share old stories of the flu, measles, TB, or smallpox killing so many in a village that the place was forever marked by death. Their ancestors, the survivors, chose to move away.

Care for the orphans of the flu became a pressing concern. Those villagers who could take in children did their best. Some children were housed at area canneries as a temporary measure. By July, the worst was over, but at the close of fishing season, when cannery operators were preparing to shut down, they sought help from the government. The orphans numbered in the hundreds.

Ultimately the government facility at Kanakanak was deemed the best option for taking care of the children. French converted a school building into a hospital, the first permanent medical facility in the region, and built an orphanage that would operate until 1930. Other epidemics, though none as virulent as the Spanish flu, would strike the region, and these and other orphaned children grew up together, further mingling the cultures of the Aleut, Yup'ik, Athabascan, Russian, Scandinavian, and other peoples.

At the time, centralized institutional care for the orphans seemed the best solution, yet growing up apart from family and seasons of life in their home villages, the children also experienced long-term cultural loss. One portion of the 1994 Alaska Natives Commission report addressed the issue: "Native cultures were not the only casualties of the assault of diseases and the invasion of Western life. Also wounded, and in some cases nearly destroyed, were the family and kinship systems that governed everyday life. These systems included clear delineations of relationships, responsibilities, and rights of all the members of a family and village: grandparents and other elders, parents, brothers, sisters, uncles and aunts."

The hospital and orphanage at Kanakanak had been operating for 10 years when three-year-old Aleck Giaconetti arrived in 1929, after his mother died of tuberculosis, yet another disease taking Native lives. Giaconetti wasn't truly orphaned, as his father Charles was a winter mail carrier and the watchman for a salting station at Coffee Creek, above Egegik. But the grieving widower was left with three children, Aleck and his two young sisters. To add to his troubles, that year there also was a terrible flood that unseated the foundation of their home. It was no longer level. Charles was forced to make a terrible decision.

"So my dad decided, after my mother died, they took us up to Kanakanak, and that was where the hospital was, and of course the orphanage," Giaconetti said in a 1998 interview at his home in Chignik Lagoon. "All these people were dying of something that I think may have been scarlet fever, but it may have been something related to tuberculosis. People called it consumption."

Although he had a bed and hot meals at Kanakanak, Giaconetti was afraid and confused. Even seven decades later, his memories of the winter of 1928-29 were mingled with visions of death.

"During the time that I was there I'd see people wheeled in and then, three days later, they were wheeled out. They were dying. They couldn't bury them fast enough because the ground was frozen. So they just put them on layers of ice and then covered them with ice.

"I survived that epidemic. I was in the Kanakanak Orphanage for four months when all those people were dying." Even as the orphans grew up, Giaconetti says, their death rate was higher than normal. "There were a lot of kids that went to the orphanage schools. In the 1960s, not even half of them were still alive. They died."

That spring, the Giaconetti children were packed off to Seward, and from there they were taken to the old army installation at Tanana, which had been converted into an orphanage. There Giaconetti spent the next three years. Then came another move, this time to the orphanage and school at Eklutna. As an adult, Giaconetti eventually settled back on the Alaska Peninsula, where he was born and where most of his family tree was rooted -- around Ugashik and Egegik -- except for his blue-eyed Italian ancestor who came to Alaska and married Aleck's Eskimo grandmother.

Although the orphanage closed in 1930, Kanakanak Hospital and school continued operating. The Bureau of Education ship, the Boxer, made occasional visits with supplies in the summer months. Also onboard the Boxer were government doctors and nurses who held clinics at coastal villages. In winters, the Bureau's itinerant medical staff traveled by dog team to reach Interior villages.

After World War II, the coastal villages of the Alaska Peninsula, and elsewhere in Alaska, were served by two "floating clinics": the M/V Health and M/V Hygiene. Arriving once or twice a year, the ships would radio ahead to each village, letting them know when they expected to anchor. Older Bristol Bay villagers of today recall their teachers canceling school for a day as the children lined up for lung X-rays, inoculations, and teeth-pulling.

George Krause of Dillingham remembered Kanakanak Hospital during the 1930s because his father served as a medical assistant there.

"He knew how to doctor pretty good," Krause said in 1998, when he was living at the Dillingham Senior Center. "[My father] had a lot of medicine."

Krause, who grew up in Aleknagik, lived and worked in the region until his death at age 77 in 2003. For more than a half-century, he was a pilot who hauled passengers, mail, freight, and medical patients, as well as spotting for herring.

Before medevacs were a way of life in the Bristol Bay area, villagers counted on pilots like Krause to transport them to Kanakanak, or to Anchorage hospitals.

"One time between here and Togiak, a man was sick and had TB," Krause said. "We had to land, it was kind of fogged-in, getting dark. We spent the night in the airplane. Next day we left for Kanakanak, and he caught pneumonia and died from that."

More memories hold happy endings, such as the time he flew a woman in advanced labor, arriving at Kanakanak just in time to avoid delivering the baby himself. And he was thanked by a man who claimed Krause had saved his life twice: once when Krause flew him to the hospital from Clarks Point and once when he flew him from Kanakanak to Anchorage, when the bleeding from a tonsillectomy wouldn't stop.

In 1955 the U. S. Public Health Service took over operation of the hospital from the Bureau of Indian Affairs, and the building saw major renovations in the 1960s. At the same time, people in each village were training as health aides and could radio doctors for medical advice.

Since 1980, the Bristol Bay Area Health Corporation has overseen Dillingham's Kanakanak Hospital for the Indian Health Service. Kanakanak remains the central facility for health care needs of the Bristol Bay area, supported by clinics and staffed by the Community Health Aide Program (CHAP) in each village. The hospital has evolved into a modern, 16-bed facility offering a wide range of health care services to the Native people of the area.